Light Adjustable Lens (LAL) using Yamane intrascleral flanged fixation for traumatic aphakia: A case report

To describe the novel use of a Light Adjustable Lens (LAL) implanted using Yamane flanged intrascleral fixation for the management of post-traumatic aphakia without capsular support.

A 60-year-old male presented with aphakia in the right eye following remote ocular trauma during adolescence. Preoperative corrected distance visual acuity was 20/70 with a hyperopic refraction of +9.00 + 3.50 × 87. Biometry revealed high corneal astigmatism (4.43 diopters) and an axial length of 23.52 mm. In the absence of capsular support, a +19.5 D LAL was implanted using the Yamane double-needle flanged intrascleral fixation technique. Postoperatively, the patient underwent four light-delivery treatments over 14 weeks. By week 14, corrected distance visual acuity improved to 20/40-2 with uncorrected distance visual acuity of 20/70-2. Final manifest refraction was 0.00 -2.50 × 180, achieving excellent binocular alignment with the fellow eye. The lens remained well centered throughout follow-up, with no intraoperative or postoperative complications such as cystoid macular edema or elevated intraocular pressure.

This case demonstrates the feasibility of combining Yamane flanged intrascleral fixation with the LAL in post-traumatic aphakia, providing both stable fixation and the unique advantage of postoperative refractive adjustment. In contrast to the refractive unpredictability typically associated with secondary intraocular lens implantation, the LAL enabled precise refinement of the final refractive outcome. These findings highlight the potential role of the LAL in expanding the refractive precision of secondary intraocular lens surgery, particularly in anatomically complex eyes.